Here's the summary from the radiologists' report:
A single new mildly PET avid liver lesion is present. The previously seen liver lesions are not significantly changed.
What this means as a first order effect is that Rumsfeld (tumor #3) is not as gone as December's CT and this past Thursday's MRI had led us to believe. Also, more importantly, that a new tumor, Ashcroft (tumor #4), has appeared. My oncologist believes that there is some ambiguity on the PET about tumor #4, so it's slightly possible this is a false positive.
As for second order effects, I really don't know what this means yet. I'll be seeing my oncologist Monday morning, which meeting should give me some additional insight, but I believe they want to take this to the Tumor Board at my cancer center before giving me what passes for definitive answers in oncology. That is a medical specialty that runs on statistics and post hoc analysis, so definitive answers are notoriously thin on the ground.
Possibilities and questions include:
- What does it mean for the chemo series if one tumor shrinks (Rumsfeld) and another grows (Ashcroft)? These are simultaneously the most positive and the most negative results we've ever seen from chemo for me. How can the chemo be both effective and ineffective at the same time?
- Do we abandon this chemo sequence (FOLFOX with Vectibix) and start on the next (as-yet-unknown-to-me substrate with Stivarga)? Which would mean another six months of chemo going forward from here.
- Now that we have four surgical targets in three disparate locations in my liver, is surgery still an option? (That's actually a question for my surgical oncologist, who I'm seeing in a week and a half.) Is it effective to do a resection and leave some diseased tissue in place? One of the issues here is that because I've had two prior liver resections, my liver is rather structurally compromised. My surgical oncologist has already expressed an opinion to me that he wants to be very conservative on this go round to avoid risk of surgically-induced liver failure. It's unclear to me how we reconcile this requirement for a conservative approach with the continued spread of my tumors.
- How much closer does this move me to a terminal diagnosis?
It's hard to see how this isn't quite grim, unless there's some other way to interpret the PET results. I don't really know what to think yet. At the moment, I'm mostly very angry and confused, and also very concerned for the impact of this news on those around me whom I love.
More when I have it.